Transformation of a pericardial cyst observed on long-term follow-up

Pericardial Cyst at an Unusual Location: The Role of CT Imaging

The pericardial cyst is a benign, uncommon congenital cystic lesion of pericardial origin located in the anterior and middle mediastinum. Most commonly, pericardial cysts are located in the right anterior cardiophrenic angle. Computed tomography (CT) and magnetic resonance imaging (MRI) of the chest are the non-invasive imaging modalities for the diagnosis of the pericardial cyst. Here we present a case of a 55-year-old male who presented with coughing and chest pain for two weeks. A chest X-ray revealed a soft-tissue opacity mass in the left lower zone. A CT of the chest showed a fluid-density cystic lesion in close proximity to the pericardium, located along the left posterior cardiophrenic angle, an uncommon location for a pericardial cyst.

[Pleuropericardial cyst rupturing into the pericardium causing tamponade]

Pleuropericardial cysts of the mediastinum are rare lesions, usually congenital but exceptionally acquired. They are often asymptomatic, but complications can occur. We report below the case of a 35-year-old man who presented with an acquired right-sided para-tracheal mesothelial cyst that ruptured into the pericardium and was responsible for clinical tamponade. Although the majority of mesothelial cysts are asymptomatic, only a strict clinical and radiological follow-up can provide an indication for surgical resection. This should be reserved for symptomatic patients or for those facing an uncertain diagnosis.

Right mesothelial pericardial cyst determining intractable atrial arrhythmias

Pericardial cysts are intrathoracic lesions usually considered to be congenital and less frequently to be acquired. They are normally found incidentally upon chest radiography, computed tomography (CT)-scan or echocardiography. They are usually asymptomatic and have a benign behavior although sometimes they can cause clinical symptoms and diagnosis can be uncertain. We present, herein, the case of a 51-year-old male with a history of atrial arrhythmia resistant to transcatheter ablation therapies with an accidental finding of a pericardial cyst adherent to the lateral wall of the right atrium at the emerging superior vena cava. The patient was studied with transesophageal echocardiography, CT-scan and cardiovascular magnetic resonance with the evidence of dimensional increasing of the cyst at seriate controls. Considering this, in the absence of a definitive diagnosis and suspecting a link between the mass and the arrhythmia, the cyst was surgically removed through median sternotomy, off-pump on a beating heart. Postoperative course was unremarkable. Histopathologic examination confirmed it was a mesothelial pericardial cyst. At 12 months of follow-up the patient is doing well and he is in sinus rhythm. In conclusion, we believe that, although the majority of pericardial cysts need only radiological and clinical follow-up, surgical resection should be performed when the patient is symptomatic and when diagnosis is uncertain.

Pericardial Cyst: Case Reports and a Literature Review

Pericardial cysts are rare mediastinal abnormalities, which are usually congenital but may also be acquired after cardiothoracic surgery. Cysts frequently occur in the right cardiophrenic angle and their diagnosis is usually suspected after an abnormal chest X ray is obtained. The presence of a pericardial cyst in this typical location or, less frequently, in an unusual location, poses a diagnostic challenge in distinguishing it from other intracardiac or mediastinal abnormalities. Two-dimensional echocardiography and transesophageal echocardiography are extremely valuable in diagnosing the presence of a pericardial cyst. Although most pericardial cysts are asymptomatic, patients may present with chest pain and dyspnea. In addition, life-threatening complications such as pericardial tamponade have been reported in association with pericardial cysts. The following cases illustrate the usefulness of two-dimensional echocardiography in making an accurate diagnosis of a pericardial cyst, as well as in follow-up of these patients for the development of possible complications.